Author Archive

Getting The Most Out Of Your Exercise

Author: Dr. Pierre DuBois

Finding the body’s target heart rate (THR) is essential for those interested in maximizing the effectiveness of their workouts and training programs and reducing the risk of overexertion.

The Simple Method For Calculating Your Target Heart Rate

There is an easy method for determining your THR: Start by subtracting your age from 220 (226 for women); this will provide your estimated maximum heart rate (MHR). Multiply your MHR by the percentages listed for the appropriate exercise zone from the list below.

Healthy Heart – For low-intensity exercises and warm ups. The THR for this zone is 50%-60% of the MHR.

Fitness – For more intense but generally low to moderate effort exercises. The THR for this zone is 60%-70% of the MHR.

Aerobic – This zone helps build endurance and increases the strength and size of your heart. It also improves your cardiovascular and respiratory system. The THR for this zone is 70%-80% of the MHR.

Anaerobic – For performance training. This zone increases the amount of oxygen you can consume during physical exertion. The THR for this zone is 80%-90% of the MHR.

Red Line – For maximum intensity exercises that burn the most calories. The THR for this zone is 90%-100% of the MHR. This level should only be attempted by those in excellent shape who have been cleared by a physician or qualified medical examiner.

So, for example, a 40-year-old woman who wishes to find her THR for a fitness zone program would use the following equation: (226 – 40) X 60% = 111 (low end) and (226 – 40) X 70% = 130 (high end). Therefore, as long as she maintains her heart rate between 111 beats per minute (bpm) and 130 bpm, the woman is at the proper target heart rate for maximum exercise efficiency and safety.

A More Accurate Method

A more accurate method for determining your THR is the Karvonen formula, but this requires that you determine your resting heart rate (RHR) and your heart rate reserve (HRR). Measure your resting pulse (your heart rate just as you wake up) three mornings in a row. Your RHR is the average of these three readings (add the readings and divide by three). Your HRR is your MHR minus your RHR. Once you have calculated your HRR, multiply it by the percentages for the zone you want to target for and add the RHR. The equations are as follows:

The Fine Print Behind The Misleading Headline

Author: Dr. Stephen Chaney

I hadn’t paid much attention to the headlines saying “Statin Use May Decrease Parkinson’s Risk” until the other day when I happened to glance a couple of lines below the headline and spotted a statement saying “Study Shows That Discontinuation of Statin Therapy Increases Risk of Parkinson’s”.

I immediately said to myself “That’s bizarre. There is a total disconnect between the headlines and the study.” If you really wanted to determine whether statin use reduced the risk of Parkinson’s, you would compare the incidence of Parkinson’s disease in a group of statin users and a matched group who did not use statins.

It turns out those studies have been done, and they were inconclusive – some studies showed a slight increase in Parkinson’s in statin users, some showed a slight decrease, and most showed no correlation between statinuse and Parkinson’s.

In that context, this study could equally well have been interpreted as suggesting that statin use increased the risk of Parkinson’s, but somehow none of the headlines mentioned that possibility.

Are Both Possibilities Plausible?

Let’s look at each possibility in detail. The reasoning is complex, but let me try to walk you through it.

Could Statins Decrease The Risk Of Parkinson’s

Parkinson’s is caused by the progressive degeneration of the brain neurons that produce a chemical messenger called dopamine that controls muscle movement. However, the causes of nerve degeneration in Parkinson’s patients are largely unknown.

Genetics may play a small role. Environmental toxins may play a role. But most experts feel that Parkinson’s patients produce an excess of free radicals, and it is the oxidative damage caused by those free radicals that results in the loss of the ability of neurons to produce dopamine.

But even that is not the whole answer. The brain is normally able to use coenzyme Q10, which is very abundant in brain, and other antioxidants to destroy free radicals before they damage brain neurons. Somehow in Parkinson’s patients free radical production and antioxidant production have gotten out of balance.

Advocates of the theory that statins may decrease the risk of Parkinson’s, point out that statins decrease oxidative damage. So if a person was predisposed to developing Parkinson’s and oxidative damage is a major cause of Parkinson’s, it is theoretically possible that statins could slow the progression to Parkinson’s while they were taking the drug. Of course, once they stopped taking the drug the oxidative damage to dopamine-producing neurons would resume and Parkinson’s would eventually develop.

In this model- Let’s call it Model A:

1) Oxidative damage of dopamine-producing neurons was caused by some unspecified external agent.

2) Statins protected the neurons from oxidative damage while they were being used.

3) Once the statin drugs were discontinued oxidative damage resumed and the risk of developing Parkinson’s increased.

This is the model favored by the authors and repeated in all of the headlines you saw.

Could Statins Increase The Risk Of Parkinson’s?

Statins also interfere with the synthesis of cholesterol and coenzyme Q10, and these are both absolutely essential for brain function. Let’s start with cholesterol:

20% of the body’s membrane cholesterol is found in the myelin sheath that coats the brain’s neurons (You can think of the myelin sheath as analogous to the plastic coating that insulates an electrical wire).

Cholesterol can’t cross the blood-brain barrier, which means that the brain cannot utilize cholesterol from the bloodstream . It has to make its own cholesterol.

As for coenzyme Q10:

It is not only a powerful antioxidant. It is also absolutely essential for cellular energy production.

The brain has tremendous energy requirements. The brain accounts for 20% of the energy utilization of our body. Neurons burn 2 times more energy than other cells in our body.

For both of these reasons, many experts have cautioned that statin drugs have the potential to cause neurodegenerative diseases such as Parkinson’s. In this model – Lets call it model B:

1) The statin drugs themselves are damaging the dopamine-producing neurons by inhibiting cholesterol and coenzyme Q10 synthesis in the brain.

2) The antioxidant effects of the statin drugs were masking the damage caused by the statins while the drugs were being used.

3) Once the statin drugs were discontinued the underlying damage was unmasked and the patients quickly developed Parkinson’s.

What Did The Study Actually Show?

The study (Lee et al, Neurology, 81: 410-416, 2013) looked at 43,810 statin users on the island of Taiwan. The Taiwanese Health System keeps extensive records of prescription use and health conditions of everyone on the island. It also requires that statin use be discontinued as soon as the patient reach their target of < 100 mg/dL LDL cholesterol, so they had the perfect population base to study what happens when you discontinue statin therapy.

The results were:

The patients who discontinued statin therapy were 42% less likely to develop Parkinson’s that those who continued on statin therapy. That result is consistent with both models A & B.

The increased risk of developing Parkinson’s when the drug was discontinued was only seen for the statin drugs like simvastatin and atorvastatin that are able to cross the blood brain barrier. That result is actually a bit more consistent with model B (Remember that the brain has to be able to make its own cholesterol and statins block cholesterol production).

When the study compared people using statin drugs to those not using statin drugs there was no significant difference in the prevalence of Parkinson’s – even for those statin drugs that cross the blood brain barrier. That means that merely being on a statin drug did not influence the risk of developing Parkinson’s. It was only when patients were on statin drugs for a period of time and were subsequently taken off statins that the risk of developing Parkinson’s was affected – and the effect was to increase risk! In the context of the first two findings, that result is also a bit more consistent with model B.

The Bottom Line:

If I were writing one of those medical blogs, I would have probably have gone with the party line and told you that statins decrease your risk of developing Parkinson’s. And if I were one of those health bloggers who never let the facts get in the way of a good story, I’d probably be scaring you with headlines saying that statins increase your risk of Parkinson’s.

But, I’m a scientist. I actually read the article, and I tell it to you like it is. Here’s your bottom line.

1) Ignore the headlines. The study they are talking about can’t distinguish between statins increasing or decreasing the risk of Parkinson’s. Don’t let anyone tell you that reducing the risk of Parkinson’s is a side benefit of statin therapy. That simply has not been proven.

2) The study does clearly show that discontinuing the statin drugs simvastatin and atorvastatin is associated with increased risk of developing Parkinson’s. That’s a big red flag for me, because 53% of patients discontinue statin therapy because of side effects, cost or other reasons.

3) However, statin drugs do save lives, especially for people who have already had a heart attack, so talk with your doctor about the benefits and risks of statin drugs, and which statin drugs are best for you.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Making Hip Pain Go Away

Author: Julie Donnelly

Do you have joint pain or stiffness? Does it hurt when you’ve been sitting and you try to get up and walk? Have you tried to stretch and either it feels good for a few minutes and then you’re back to square one, or maybe even worse, it hurts more than it did before? Do you sometimes feel like your joints are just tied down and you’re no longer flexible? Do you maybe even blame it on “old age?” The odds are extremely high that all that’s happening is your muscles are in spasm.

If any of these statements fit you, you’ll really love today’s message. As a bonus, at the end of this blog you’ll learn a self-treatment that you’ll love if you ever have hip pain.

I’ve mentioned many times that a tight muscle pulling on a tendon will cause joint pain, just like pulling on your hair will cause your scalp to hurt. And, just like the only way to stop the pain in your head is to let go of your hair, the only way to stop the pain in your joint is to release the tight muscle.

Another analogy that I use frequently has to do with stretching and why you may feel worse AFTER you stretch than you did before you stretched. If you took a 12” line and tied enough knots in it so it is now 11”, and then you try to stretch it back to 12” without first untying the knots, you can see what would happen. The knots would become tighter and the fibers on either side of the knot would be overstretched and could possibly even tear. If the line was attached to a fixed point on either side you can imagine the strain that is happening to the attachment points. This is exactly what is happening to you when you when you stretch a muscle that is tied up in knots (spasms). You can see how important it is to first release the spasms before stretching.

Today I’d like to share with you how to do one of the Julstro self-treatments that we teach on the Julstro self-treatment DVD. So many people have hip pain that I’d like to explain how to treat the tensor fascia lata muscle which is located on the outside of your hip, between your hip bone and the top of your thigh bone:

Using a tennis ball (hollow in the center so it is a bit less intense) or a Perfect Ball (solid in the center so it gets in deeper) place the ball right where the side-seam of your pants is located – between the two bones. If you are in a lot of pain, start by leaning into a wall. If you want to go deeper into the muscle, lie on the floor on top of the ball. You may need to move an inch or so to find the “epicenter” of the spasm, but you’ll know immediately when you locate it. Always make sure you keep your pressure to a “hurts so good” level, you’re in control so don’t over-do.

Once you find the spasm, which is also called a “trigger point,” just stay still on it for 30-60 seconds. Lift your weight off the ball for a few breaths and then press into the ball again. This second time you’ll find that it won’t be as painful as the first time because you have already pressed out some of the H+ ions that are causing the spasm (and the pain).

Keep repeating this for a few minutes and then slightly move your body so you can find other trigger points that are around your hips. You’ll probably find points that are a little bit toward the front of your hip, so make sure you rotate your body so you’re facing more toward the wall or the floor, and then rotate your body so you’re back is more toward the wall or the floor.

This one simple technique has saved several of my clients from thinking they needed hip surgery! It will help you move easier and with less discomfort – and often it will totally eliminate the pain from your hip completely.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Is Eating Right For Your Blood Type A Sham?

Author: Dr. Stephen Chaney

Does the Blood Type Diet really work? In 1997 Dr. Peter J. D’Adamo wrote a book about the blood type diet called “Eat Right 4 Your Type”. Dr. D’Adamo claims that people with different blood types process food differently, so their blood type determines the type of diet that is healthiest for them. Specifically, he claims that people with:

Blood group O are descended from hunters and should consume high protein diets.

Blood group A are descended from farmers and should consume a near vegetarian diet – completely avoiding red meats.

Blood group B are descended from nomads. They have the most flexible digestive system and can eat the widest variety of foods – even dairy products, which he does not recommend for any of the other blood types.

Blood group AB are an enigma and are somewhere between blood group A and blood group B.

It’s an interesting concept. Dietary recommendations are made for populations as a whole, and there is tremendous genetic variation in populations. Because of that genetic variation, there is no perfect diet for everyone. Every knowledgeable health expert will tell you that.

The question then becomes “How do you know what kind of diet is healthiest for you?”

The blood type diet is a very simple system. Your blood type is easy to determine. Once you know your blood type you know what to eat. There’s no guesswork.

Could it really be so simple? Over 7 million copies of Dr. D’Adamo’s book have been sold. Millions of people believe in this concept. So it is only fitting to ask “What is the evidence?”

An Objective Scientific Analysis of the Blood Type Diet

There is no doubt that blood type is related to some human genetic and physical traits, but the important question is whether blood type is related to the health outcomes of different diets – the central thesis of Dr. D’Adamo’s book. A Belgian group lead by Dr. Emmey De Buch did a systematic search of the scientific literature to answer that very question (L. Cusack et al, Am J. Clin. Nutr. , 98: 99-104, 2013).

They identified 1415 scientific articles that had the phrase “blood type diet” in either the title or abstract. Then they begin the elimination process. They eliminated:

“Exercise” Versus “Lifestyle Activity”:

How Active Are You—Really?

Author: Dr. Pierre DuBois

The most frequent questions I get are: “How much exercise do I need?” and “What’s the best way of getting that exercise?” If you are like most people, working out just for the sake of working out does not really appeal (although there are many dedicated gym buffs who couldn’t live without their daily workouts!).

We all know that it’s important to exercise regularly if we want to live a long and healthy life. However, if you find the idea of trotting along on a treadmill for 15 minutes and then spending half an hour of working out on Nautilus machines to be about as exciting as a trip to the dentist, then this article is for you!

What the Experts Recommend:

Experts recommend that we get at least 150 minutes of exercise each week to stay in shape. But many people find taking this much exercise at once (or in three 50-minute stretches) too daunting.

The good news is that a recent study conducted by researchers at Boston University that was published in the journal Medicine & Science in Sports & Exercise found that bouts of exercise lasting less than 10 minutes a couple of times daily, such as the kind you get when cleaning the house, were sufficient to meet your weekly exercise needs.

What the Study Showed

Over 2,000 participants were included in the study, more than half of whom were overweight. Motion detectors were attached to each of the subjects for eight days, and an average of half the participants met their weekly exercise quota of 150 minutes. The average participant met his or her quota with exercise that lasted less than 10 minutes at a time. The types of exercise ranged from moderate (heavy cleaning, walking briskly and sports such as golf and badminton) to vigorous (running, hiking, shoveling and farm work).

As long as the participants met their 150-minute per week quota, no matter the length of their exercise, they had lower body mass index, smaller waists, lower triglycerides and better cholesterol levels than those who did not meet the quota.

Assistant professor at Boston University’s School of Medicine, Nicole Glazer, says “This study really speaks to the idea that some activity is better than nothing. Parking a little bit farther away, getting off the bus one stop early—all of these little things can add up and are related to a healthier profile.”

For years, researchers have studied the effects of exercise from practicing sports or visiting the gym. However, according to Glazer, “This idea of lifestyle activity is one that is under-measured in research studies.” Activities such as taking the stairs instead of the elevator, using a push mower instead of a riding mower, etc. can add up to a significant amount of energy expenditure. Experts still stress that it’s important to also get in some traditional forms of exercise and not merely replace it with lifestyle activity. Still, any exercise is useful.

“The levels of sedentary behavior in this country are alarming. So the concern that someone’s going to stop exercising and instead just get off the bus a stop earlier, that’s not my concern,” Glazer says. “The real concern is, is this a stepping-stone? Is this the way we can get inactive people to do any sort of activity? People will come up with any excuse to not exercise. I don’t need to worry about my giving them one. They’ll be able to think of something.”

The Bottom Line:

Experts recommend 150 minutes of moderate intensity exercise a week

That doesn’t mean that you need to be a gym rat or marathoner. Ten minute exercise intervals centered around everyday lifestyle activities can be sufficient.

So you are out of excuses. You have the time. You have all the equipment you need. You don’t even need special workout clothes.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Are high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

It’s the fat – not the pounds – that causes most of the health problems.

Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.

When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).

The second group’s diet contained 2X the RDA for protein (28% of calories)

The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

What Did The Study Show?

Weight loss (7 pounds in 21 days) was the same on all 3 diets.

The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.

The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.

In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.

The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1) Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2) That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3) Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4) Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5) These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary. I do not recommend them.

6) This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7) The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

How Can You Work Exercise Into Your Travel Schedule?

Author: Kai Fusser, MS

Many of my clients ask me “How can I stay fit while I’m on the road?” If you are traveling for work or leisure, traveling and working out can be a challenge, finding a gym, time, convenience and more gets in the way. For my athletes exercise is a must and getting it done is part of their job even though they have the same challenges. But also for us non-athletes, we want to stay fit even during travel, it also makes us feel better and can help with jet lag and combat the effects of “travel” food.

Travel Exercise Tips;

Now we should realize that we don’t need a gym to get a good workout in, a hotel room or some outdoor space can be sufficient. We also don’t necessarily need any equipment although bringing along a jump rope and a rubber band can add to the variety of on the road exercises.

So here are some ideas for simple ways to exercise, feel free to be inventive, our body can move in many ways and we need to take advantage of that.

The power of walking: walking is one of the most natural and healthiest movements for us, it uses our whole body, stimulates the circulatory and nervous system, massages our organs and is relaxing. Take a 30-60 min. walk in a park, neighborhood or city, if done in the evening it will help you sleep better as well.

Use your own body: here we can take advantage of our own body weight and gravity, there are countless exercises that can be done in a tight space, try to do 3 sets of 8-15 reps for each exercise, alternating between different exercises will save time. Here are some good ones: pushups with different arm widths, lunges in all different directions, squats, crunches with different leg positions, dips on a chair, regular and side planks, wood chop up, shot put etc.

Cardio: here I recommend the burst training as it is the most efficient in time and effect, 4-6 minutes alternating between slow and sprint pace at 20 sec. slow and 10-20 sec. sprint ratio. This can be done by running in place with use of arms, rope jumping, hotel stairways, shadow boxing (no worries you are alone in the room).

The ultimate way: if you really want a challenge and get things done quick do 3-5 sets of either Turkish get ups or pushups to jump (also called burpees) at high speed.

In the hotel gym: hotel gyms are often “compromise gyms” but most have a treadmill (turn the motor off and push the belt while holding on) or a bike where the burst training can be done which I recommend over the long slow cardio for its effectiveness and its much easier to convince yourself of doing a short 4-6 min. workout verses a 45-60 min. long haul.

It is best to keep the workout short in time but high in intensity according to your fitness level.

Also remember your nutrition during travel, I know it is very challenging as we get out of our routine, but making the right choices (why not stopping at the super market for some healthy snacks before checking in) and eating in moderation will go a long ways towards still feeling good when you get back home.

Remember to keep it simple and fun so traveling doesn’t have to be a threat to your health.

Should You Eat Breakfast Every Day?

Author: Dr. Stephen Chaney

Does skipping breakfast actually increase your risk of heart attacks? You’ve probably heard the saying “Eat breakfast like a king, lunch like a prince, and dinner like a pauper”.

You’ve probably also heard that skipping breakfast is associated with increased risk of things like:

obesity

high blood pressure

and diabetes

If you believe those associations are true, the latest study showing an association between skipping breakfast and heart disease risk just makes sense. After all, obesity, high blood pressure and diabetes all increase the risk of heart disease.

But, how good is the evidence skipping breakfast actually increases the risk of any of those things?

The evidence for the link between skipping breakfast and heart disease risk:

Let’s start with the current study linking breakfast skipping with heart disease (Cahill et al, Circulation, 128: 337-343, 2013) because its study design is similar to the studies linking breakfast skipping to obesity, high blood pressure and diabetes. This study surveyed the eating habits of 27,000 men (45+ years old) enrolled in the Health Professionals Follow-Up Study in 1992 and followed those men for 16 years.

The results were pretty dramatic. After correcting for other factors that might influence heart disease risk, the men who skipped breakfast were 27% more likely to develop heart disease over the next 16 years than the men who ate breakfast on a daily basis.

As impressive as the association between breakfast and heart disease was, there was an even more impressive association that never made it into the headlines.

There was no association between skipping breakfast and eating late in the evening. However, those men who ate late in the eveningwere 53% more like to develop heart disease than men who did not.

The pros and cons of the study:

The pros:

1) The strength of this study is that it is large (27,000 participants), long (16 years) and well designed. The results were statistically very significant.

The cons:

1) This study only shows associations. It does not prove cause and effect. Having said that, it would be really, really hard to design a placebo controlled study for breakfast versus no breakfast. So cause and effect is almost impossible to prove for this type of comparison.

2) The study did not ask what kind of breakfast the participants were eating. We don’t know whether the breakfasts were a Danish and coffee, an Egg McMuffin and hash browns or a high protein smoothie with perhaps some fruit or oatmeal– and, believe me, there is a difference among those three breakfasts!

The Bottom Line:

1) Eating breakfast is probably a good thing. Yes, the evidence that skipping breakfast increases heart disease risk is circumstantial, but it is also substantial. This is a large, well designed study.

2) Not all breakfasts are equal. You probably already knew that! I recommend a breakfast with fruit, nuts, whole grains in moderation and lean protein sources.

3) While this particular study only included men, previous studies suggest that the potential health risks of skipping breakfast are equally strong for women.

4) Finally, while skipping breakfast grabbed all the headlines, the data suggest that eating late at night is an even stronger predictor of heart disease risk.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

Recent Videos From Dr. Steve Chaney

Latest Article

A Low Carb Diet and Weight Loss

Posted January 15, 2019 by Dr. Steve Chaney

Do Low-Carb Diets Help Maintain Weight Loss?

Author: Dr. Stephen Chaney

Traditional diets have been based on counting calories, but are all calories equal? Low-carb enthusiasts have long claimed that diets high in sugar and refined carbs cause obesity. Their hypothesis is based on the fact that high blood sugar levels cause a spike in insulin levels, and insulin promotes fat storage.

The problem is that there has been scant evidence to support that hypothesis. In fact, a recent meta-analysis of 32 published clinical studies (KD Hall and J Guo, Gastroenterology, 152: 1718-1727, 2017 ) concluded that low-fat diets resulted in a higher metabolic rate and greater fat loss than isocaloric low-carbohydrate diets.

However, low-carb enthusiasts persisted. They argued that the studies included in the meta-analysis were too short to adequately measure the metabolic effects of a low-carb diet. Recently, a study has been published in the British Medical Journal (CB Ebbeling et al, BMJ 2018, 363:k4583 ) that appears to vindicate their position.

Are low carb diets best for long term weight loss?

Low-carb enthusiasts claim the study conclusively shows that low-carb diets are best for losing weight and for keeping it off once you have lost it. They are saying that it is time to shift away from counting calories and from promoting low-fat diets and focus on low-carb diets instead if we wish to solve the obesity epidemic. In this article I will focus on three issues:

How good was the study?

What were its limitations?

Are the claims justified?

How Was The Study Designed?

The investigators started with 234 overweight adults (30% male, 78% white, average age 40, BMI 32) recruited from the campus of Framingham State University in Massachusetts. All participants were put on a diet that restricted calories to 60% of estimated needs for 10 weeks. The diet consisted of 45% of calories from carbohydrate, 30% from fat, and 25% from protein. [So much for the claim that the study showed low-carb diets were more effective for weight loss. The diet used for the weight loss portion of the diet was not low-carb.]

During the initial phase of the study 161 of the participants achieved 10% weight loss. These participants were randomly divided into 3 groups for the weight maintenance phase of the study.

The diet composition of the high-carb group was 60% carbohydrate, 20% fat, and 20% protein.

The diet composition of the moderate-carb group was 40% carbohydrate, 40% fat, and 20% protein.

The diet composition of the low-carb group was 20% carbohydrate, 60% fat, and 20% protein.

Other important characteristics of the study were:

The weight maintenance portion of the study lasted 5 months – much longer than any previous study.

All meals were designed by dietitians and prepared by a commercial food service. The meals were either served in a cafeteria or packaged to be taken home by the participants.

The caloric content of the meals was individually adjusted on a weekly basis so that weight was kept within a ± 4-pound range during the 5-month maintenance phase.

Sugar, saturated fat, and sodium were limited and kept relatively constant among the 3 diets.

120 participants made it through the 5-month maintenance phase.

Do Low-Carb Diets Help Maintain Weight Loss?

The results were striking:

The low-carb group burned an additional 278 calories/day compared to the high-carb group and 131 calories/day more than the moderate-carbohydrate group.

These differences were even higher for those individuals with higher insulin secretion at the beginning of the maintenance phase of the study.

These differences lead the authors to hypothesize that low-carb diets might be more effective for weight maintenance than other diets.

What Are The Pros And Cons Of This Study?

This was a very well-done study. In fact, it is the most ambitious and well-controlled study of its kind. However, like any other clinical study, it has its limitations. It also needs to be repeated.

The pros of the study are obvious. It was a long study and the dietary intake of the participants was tightly controlled.

As for cons, here are the three limitations of the study listed by the authors:

#1: Potential Measurement Error: This section of the paper was a highly technical consideration of the method used to measure energy expenditure. Suffice it to say that the method they used to measure calories burned per day may overestimate calories burned in the low-carb group. That, of course, would invalidate the major findings of the study. It is unlikely, but it is why the study needs to be repeated using a different measure of energy expenditure.

#2: Compliance: Although the participants were provided with all their meals, there was no way of being sure they ate them. There was also no way of knowing whether they may have eaten other foods in addition to the food they were provided. Again, this is unlikely, but cannot be eliminated from consideration.

#3: Generalizability: This is simply an acknowledgement that the greatest strength of this study is also its greatest weakness. The authors acknowledged that their study was conducted in such a tightly controlled manner it is difficult to translate their findings to the real world. For example:

Sugar and saturated fat were restricted and were at very similar levels in all 3 diets. In the real world, people consuming a high-carb diet are likely to consume more sugar than people in the other diet groups. Similarly, people consuming the low-carb diet are likely to consume more saturated fat than people in the other diet groups.

Weight was kept constant in the weight maintenance phase by constantly adjusting caloric intake. Unfortunately, this seldom happens in the real world. Most people gain weight once they go off their diet – and this is just as true with low-carb diets as with other diets.

The participants had access to dietitian-designed prepared meals 3 times a day for 5 months. This almost never happens in the real world. The authors said “…these results [their data] must be reconciled with the long-term weight loss trials relying on nutrition education and behavioral counseling that find only a small advantage for low carbohydrate compared with low fat diets according to several recent meta-analyses.” [I would add that in the real world, people do not even have access to nutritional education and behavioral modification.]

What Does This Study Mean For You?

This study shows that under very tightly controlled conditions (dietitian-prepared meals, sugar and saturated fat limited to healthy levels, calories continually adjusted so that weight remains constant) a low-carb diet burns more calories per day than a moderate-carb or high-carb diet. These findings show that it is theoretically possible to increase your metabolic weight and successfully maintain a healthy weight on a low-carb diet. These are the headlines you probably saw. However, a careful reading of the study provides a much more nuanced viewpoint. For example, the fact that the study conditions were so tightly controlled makes it difficult to translate these findings to the real world.

In fact, the authors of the study acknowledged that multiple clinical studies show this almost never happens in the real world. These studies show that most people regain the weight they have lost on low-carb diets. More importantly, the rate of weight regain is virtually identical on low-carb and low-fat diets. Consequently, the authors of the current study concluded “…translation [of their results to the real world] requires exploration in future mechanistic oriented research.” Simply put, the authors are saying that more research is needed to provide a mechanistic explanation for this discrepancy before one can make recommendations that are relevant to weight loss and weight maintenance in the real world.

The authors also discussed the results of their study in light of a recent, well-designed 12-month study (CD Gardener et al, JAMA, 319: 667-669, 2018 ) that showed no difference in weight change between a healthy low-fat versus a healthy low-carbohydrate diet. That study also reported that the results were unaffected by insulin secretion at baseline. The authors of the current study noted that “…[in the previous study] participants were instructed to minimize or eliminate refined grains and added sugars and maximize intake of vegetables. Probably for this reason, the reported glycemic load [effect of the diet on blood sugar levels] of the low-fat diet was very low…and similar to [the low-carb diet].” In short, the authors of the current study were acknowledging that diets which focus on healthy, plant-based carbohydrates and eliminate sugar, refined grains, and processed foods may be as effective as low-carb diets for helping maintain a healthy weight.

This would also be consistent with previous studies showing that primarily plant-based, low-carb diets are more effective at maintaining a healthy weight and better health outcomes long-term than the typical American version of the low-fat diet, which is high in sugar and refined grains. In contrast, meat-based, low-carb diets are no more effective than the American version of the low-fat diet at preventing weight gain and poor health outcomes. I have covered these studies in detail in my book “Slaying The Food Myths.”

Consequently, the lead author of the most recent study has said: “The findings [of this study] do not impugn whole fruits, beans and other unprocessed carbohydrates. Rather, the study suggests that reducing foods with added sugar, flour, and other refined carbohydrates could help people maintain weight loss….” This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

The Bottom Line

A recent study compared the calories burned per day on a low-carb, moderate-carb, and high-carb diet. The study concluded that the low-carb diet burned significantly more calories per day than the other two diets and might be suitable for long-term weight control. If confirmed by subsequent studies, this would be the first real evidence that low-carb diets are superior for maintaining a healthy weight.

However, the study has some major limitations. For example, it used a methodology that may overestimate the benefits of a low-carb diet, and it was performed under tightly controlled conditions that can never be duplicated in the real world. As acknowledged by the authors, this study is also contradicted by multiple previous studies. Further studies will be required to confirm the results of this study and show how it can be applied in the real world.

In addition, the kind of carbohydrate in the diet is every bit as important as the amount of carbohydrate. The authors acknowledge that the differences seen in their study apply mainly to carbohydrates from sugar, refined grains, and processed foods. They advocate diets with low glycemic load (small effects on blood sugar and insulin levels) and acknowledge this can also be achieved by incorporating low-glycemic load, plant-based carbohydrates into your diet. This is something we all can agree on, but strangely this is not reflected in the headlines you may have seen in the media.

Finally, clinical studies report averages, but none of us are average. When you examine the data from the current study, it is evident that some participants burned more calories per hour on the high-carb diet than other participants did on the low carb diet. That reinforces the observation that some people lose weight more effectively on low-carb diets while others lose weight more effectively on low-fat diets. If you are someone who does better on a low-carb diet, the best available evidence suggests you will have better long-term health outcomes on a primarily plant-based, low-carb diet such as the low-carb version of the Mediterranean diet.

For more details read the article above.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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